INFECTION prevetion and controlCONTROL

By Maria Benallick

Chain of inifection

Source

Patients People Open wounds Environment Surfaces Food

Mode of transport Air Direct contact Indirect contact

Portal Wounds Ingestion Invasive procedures

People at risk Elderly Immuno-suppressed Children Pregnancy Surgical patients Underlying illness Invasive procedures

The big four% of all idenfitied is HCAI (health care acquired infections)Pneumonia 20-25% Ventilator associated pneumonia

UTI 10-25%95% cathetersSking and soft tssut 20%(50 p% surgival wounds

Blood strems infection15%Mostly vascular lines

Main infecting pathogens

MRSA Increased resistance to VancomynClostridum dificileESBLVancomycin resistant enterococci Usually presents with

Mutli restion coliforms eg Serratia Acinetobacter, klebsiellaStaphylococci

The present position

Infection during care and treatment is comion

9% get a hcaiNHS in Edeglan perform badly in Euroope Eveicne based interveion not implement considtnely or rigourouslyAntibiotic resistance is on the increasedResitnace orbanism pos high risks for some patientsLack of surveillance dat menas lack of infmraion for clinicsaion

Bugs change very quickly

20 mins things multiplyAble to pass genetic material

Pass resistance

Don’t have the surveillance data

Each case of mrsa an CDifIs now roproted to the deparment of health

Idenifty where all good Route cause analysis of how it happens with every single patient

The presnt psosint 9% develeo HCAI (2006)100, HCAI annually500 dies

More here

The nature of the problem Patients factors sericously ill patients weakened immunity Therapeutic factors – indwelling device Organisation factors – high bed occupancy, increased patient movements Behavioural factors – high bed occupation increase patient movement Behavioural factors – poor comilce with good practice recomenedation Envirmental factors – diery intrvments, floors and walls in clinical areas

Clean the bedsShifting people around more important the keeping them infection control

“Bear below the elbows” now policy

Chain of infectin

You only need to break one link in the chain

Clostridium DifficileOne outbreak

Come side effect of antibiotics due to distrupin of floraAffected by antibiotic therapy

Disticn microbial cause anbout 30% of cased

Assoiscat with various organism, in 1977 anaerobic Spore former clostrium difficile was implicatedWhat do we need to consider?

Will stay in the environments can harbour them – espeicaly horizontal surface

Produces tw toxins and leads to a spectrum of infection from mild diarrhoewa ato fulmimant megacolon

Difficult to contrl:Spore breadingWell dispersed due to environmental soilingLack of isolation facilitiesOver used of Antibioites

Distint smell of elephants

Costriudm difficile

1977 Larson and Bartlett link Clostridum difficile with antibiolti assosicated diarrhoea and pseudomembranou colitis

Found to provece 2 toxinsA ent

More here

C Difficie outberack

Picture

December to January – nearly 100Associated with medical wardNo one identified that they had an outbreak

What is a definatiion of an outbreak2 or more associated cases

What might be causing thisStaff shortagesFast turnoverVisitorsEducation and trainingPracticeVentilation *****Use of antibiotics*****What actions were takne

Hand hygiene – handwashing with soap and water (not killed with alcohol)Do this with any diarrhoea

People rely totally on alcholDo not have one agent that does everything

Enviroment hygieneGeneral Side room/bed spaces

How close the beds are together

Commode cleaning

Antibiotic prescribingAntibiotic pharmacy – monitoring uses

EducationCohort ward Anyone with an infection and ONLY thoese with

Very epensive Empty beds Seal off empty beds

Impact of action taken

Give the system to do the job properly

And it worked

See the pretty picutr

Staff reaction Initial reluctance to work on the “diarrhoea” ward Stopping other people becoming infected

Overcome by positive attude of ward manager an conultnat

Problem arose when mumver fell

Staff moved elsewhere Uncertainly of the ward

Pushing best practicePeople were listening

Cos they could do it too!!!!!

Bed occuanancy on cohort ward

Pretty picture

MRSAStaphylococus aureus is common bacterium four on skin and nostrils of 30% healthy

Meticilillin resistancce frm of S. AHappened very quickly

Anc cause infection when MRSA can enter the bodyColonise – live they but not cause any trouble

Can colonise nose, skin, axilla, groin, wounds- They tend to have it up their nose if anything

Colonisation may lead to infction or fine may be cross infectinoo

Wounds, superficial ulcers, invasivive devices, deep abscesses, lung infection bacteraemia.

Precaution to be taken

De[ed on the natur of the enviromnt and risk to tohers

standard preacuionIsolation/cohort wars or baysScreening Pre-procedure Pre-admisionDecolonisation regimes Washing with clohexadine and nasal preparation Silver pygams For people going into hospital Where in hospitals

Antibiotic therapy for infectionPre-operative screening

Isolation nursing

Clean {dirty} clean

Factor that iflunece the need to for islationEasu of tansmionSome pornaismvve sprea more ealisy than otherroute of transmissionAddiioanl prcausiionn are required with the route of transmission is not broken with standard

precautionsEpidemilogical significnne Duty of careResistnace organisms spread through wardsPrsens of susceptible individualsMany in patitnes are susceptible to infection

Isolation NursinPrinciples Mimimis the spre of ornaism for the affect

Care shou be planned for indivudal patientsIt iss the organism ntat you are isolation nt the person with it

Preoccupations should be used for patients know or suspected to have an infectious disease local policies should be followed

Isolate and wait for resultTo see if it is or it isn’t not wait and then isolate

IsolationSingle roomHand hygieneNon-sterile gloves and aprons

Laundry bagsOn a trolley

You only take in what you need

Dispose of things inside the roomThen wash hands

Then go outThen use alcohol

Nobodies care should be compormosed because they have mrsa SO YOU HAVE TO CLEAN OF THE ENVIRMENT

Bedpan sorting outYou can wear gloves and apron in the sluice

Masks need to be fitted

Waste material

Clean equipment out before it is cleaned

Cleaning

VisitorsWash hands only

Isolation NursingPsychological effects of isolation

Generally humans do not like to be isolated away from othersFears of inectio otherHighanxiety leading to dpresionLoneliness, abandment inferioty bodem

Do not isolation a patient longer than necessary

48 hours of appropriate antibiotics then the person can come out!!!!48 hours symptom free for CD

PublicationNice guidelines

EPIC 2 guidelines

Winning ways

Health Act 2006Chief excecutives are accountable

Saving lives: redcuing infections, dliving clean and safe careEssential steps and safe clean careHelathecare commingos

Nice guidelinesWinning ways

Health act 2006Jobs on the line

Code of practice for the reption and contrl of health c

DUTIES!!!!

Estential steps o safe clean care

Audit tools

High impact interventions